Provider Demographics
NPI:1548490741
Name:STROUP-MENGE, ELIZABETH A
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:STROUP-MENGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3840
Mailing Address - Country:US
Mailing Address - Phone:701-222-0386
Mailing Address - Fax:701-255-4891
Practice Address - Street 1:101 EAST BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3840
Practice Address - Country:US
Practice Address - Phone:701-222-0386
Practice Address - Fax:701-255-4891
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)